Staff Employment Online Application

Drury University Non-Discrimination Statement

Approved by Board of Trustees 5-16-14Updated 10-1-15, Updated 9-1-16

Drury University is an open and welcoming community from a rich variety of cultures, races and socio-economic backgrounds. The mission and goals of the university dedicate the institution to being a community which “affirms the quality and worth of all peoples” and appreciates the “diversity of human culture, language, history and experience.”

Drury University does not discriminate on the basis of disability, race, color, religion, gender, age, sexual orientation, national or ethnic origin, or veteran status in its programs and activities. The following persons have been designated to handle inquiries regarding Drury’s non-discrimination policies:

Please complete and submit the fields below. Your application will be forwarded to our staff.

* = required field

Today's Date *

MM

DD

YYYY

Position *

First Name *

Middle Name *

Last Name *

Last 4 Digits of SSN *

Address *

Street Address

Street Address Line 2 / APO

City

State / Province / Region / Military Base

Postal / Zip Code

Country

Primary Phone Number *

###

###

####

Alternate Phone Number

###

###

####

Email Address *

Employment History

Please begin with the most recent

Employer *

Job Title *

Dates Employed

Start Date *

MM

DD

YYYY

Current employer

End Date

MM

DD

YYYY

Initial Wage *

Ending Wage *

Employer Address *

Street Address

Street Address Line 2 / APO

City

State / Province / Region / Military Base

Postal / Zip Code

Country

Description *

Reason for Leaving *

Supervisor's Name *

First

Last

Phone Number *

###

###

####

May we contact for reference? *

Yes

No

Do you have additional employment history to list? *

Yes

No

Employer

Job Title

Dates Employed

Start Date

MM

DD

YYYY

End Date

MM

DD

YYYY

Initial Wage

Ending Wage

Employer Address

Street Address

Street Address Line 2 / APO

City

State / Province / Region / Military Base

Postal / Zip Code

Country

Description

Reason for Leaving

Supervisor's Name

First

Last

Phone Number

###

###

####

May we contact for reference?

Yes

No

Do you have additional employment history to list?

Yes

No

Employer

Job Title

Dates Employed

Start Date

MM

DD

YYYY

End Date

MM

DD

YYYY

Initial Wage

Ending Wage

Employer Address

Street Address

Street Address Line 2 / APO

City

State / Province / Region / Military Base

Postal / Zip Code

Country

Description

Reason for Leaving

Supervisor's Name

First

Last

Phone Number

###

###

####

May we contact for reference?

Yes

No

Comments

Acquired Skills

Typing

Software

Word

Outlook

Excel

PowerPoint

Access

Additional Software

Additional Skills

Educational Background

Please begin with most recent

School *

Years Completed *

Degree / Diploma Earned *

Grade Point Average / Class Rank *

Major

Minor

Do you have additional education to enter? *

Yes

No

School

Years Completed

Degree / Diploma Earned

Grade Point Average / Class Rank

Major

Minor

Do you have additional education to enter?

Yes

No

School

Years Completed

Degree / Diploma Earned

Grade Point Average / Class Rank

Major

Minor

Professional References

Name *

First

Last

Title *

Email Address

Phone Number *

###

###

####

Years Known *

Name *

First

Last

Title *

Email Address

Phone Number *

###

###

####

Years Known *

Name *

First

Last

Title *

Email Address

Phone Number *

###

###

####

Years Known *

Additional Information

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States by completing the required Form I-9, Employment Eligibility Verification form at the start of employment.

Are you authorized to work lawfully in the United States for Drury University?

Yes

No

Will you now or in the future require Drury University to commence (sponsor) an immigration case in order to employ you (for example, H-1B, Permanent Residency, or other employment-based immigration case)? This is sometimes called sponsorship for an employment-based visa status.

Yes

No

Details

Have you plead guilty to or been convicted of a felony within the ten years preceding your application to Drury University? *

Yes

No

If your answer is YES, please state the state and county or other jurisdiction of the plea or conviction, the felony to which you were convicted or to which you plead guilty, and the case number of the prosecution:

Are you capable, with or without reasonable accommodation, of performing the activities involved in the job or occupation for which you have applied? Note: Do not answer this question unless you have been informed about the requirements of the job for which you are applying: *

Yes

No

Are you related to anyone currently employed at Drury University *

Yes

No

Please provide their name(s)

How did you find out about this job? *

Newspaper

Drury Website

Professional Association Journal, Newsletter or Online Posting

Employee Referral

Indeed.com

Missouri Career Center (jobs.mo.gov)

Springfield Chamber of Commerce

Facebook

Other

Name of Newspaper

Name of Professional Association

Name of Employee

Please specify

Additional information that you feel may be helpful to us in considering your application

I certify that attachments and answers given herein are complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In the event of employment, I understand that false or misleading information given in my application, resume or interview(s) may result in discharge.